Must!Bybolic Mirror Operation Introduction Treasure Book

*For medical professionals for reading reference

Class Notes--

"Introduction to Bronchi Mirror Operation"

Lecturer: Sun Danxiong, First People's Hospital of Yunnan Province

Chairman Mao said, "Do not fight without preparation, do not fight without confidence." The same is true of bronchial mirror inspection. Before surgery, during and after surgery, you can prepare for the success rate of surgery. Today, the small world invites Teacher Sun Danxiong, Yunnan to introduce the bronchial mirror before, middle, and post -paying attention. Matters, come and learn together!

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1. Preparation before surgery

1. Make preoperative condition evaluation: correctly evaluate the patient's condition and whether the physical condition is suitable for bronchoscopy. In case of tuberculosis patients, patients with fungal infection, patients with aneurysm, and vascular malformations, they must be careful to evaluate the patient's condition. Blind biopsy is very dangerous!

2. Understand the relative contraindications of bronchoscopy.

Activating hemoptysis;

4 weeks after acute myocardial infarction;

Platelet counting <20 × 109/L is not recommended for a trimina mirror inspection, platelet counting <60 × 109/L is not recommended for subcutaneous mirror mirrors, or the bronchial lung biopsy;

During pregnancy;

Malignant arrhythmia, unstable angina pectoris, severe cardiopulmonary insufficiency, hypertension crisis, severe pulmonary hypertension, intracranial hypertension, acute cerebrovascular events, aortic fidelid layers, aortic aortic vein, severe mental illness, and extreme failure of the whole body.

3. If no gastrointestinal dynamic abnormalities or obstruction.

During local anesthesia, fasting at 4 hours before bronchial examination should be used for fasting, and water is banned 2H before surgery;

During the whole body anesthesia, it should start fasting at 8 hours before the bronchial examination, and water forbidden water began 2H before surgery.

4. It is recommended to establish veins before checking.

5. Before checking, we should not be used for routine anti -choline drugs.

6. Patients who intend to perform bronchoscope examination are recommended to perform coagozymes time, part of the coagulation activation time, and platelet count examination to except for severe coagulation function abnormalities.

7. Before checking, the blood -derived disease should be screened to prevent medical derivative infections.

8. For patients with a history of heart disease and their risk factors, the ECG examination should be performed before the examination.

9. Patients who intend to do biopsy.

It is recommended to stop at closure gogret 5-7D in advance, and discontinue doglolo in 3-5D in advance. Small dose aspirin can be continued;

It is recommended to stop Huafarin in advance. If there is no obvious active bleeding after surgery, it can be resumed after 12-24h after the bronchial mirror inspection, that is, the operation on the day of operation on the day of the night or the second day of the second day;

Dabega ester and Lidiazan need to discontinue the drug 24h in advance, without requiring low -molecular heparin replacement.

10. Drugs are discontinued.

For patients who need to be discontinued in advance or goglo, if the coating of the coronary arteries is implanted for less than a month or the coronary arterial metal naked bracket is less than one month, they should communicate with the cardiac doctor , Commonly weighing the advantages and disadvantages of anti -platelet drugs;

For patients who need to be discontinued in advance, the risk of thrombosis can be evaluated during the suspension of the drug. If it is a low risk, there is no need to replace the low molecular heparin during the stop of the drug; otherwise, it should be replaced with low molecular heparin anticoagulation, and the drug is discontinued 24h before the bronchial mirror operation. After the use of Huafarin, it should continue to use low molecular heparin until INR can reach the treatment range.

There are many pre -operative preparations. In addition to the above, you also need to understand the patient's pre -surgery history, do well with the patient and his family members, and master these in order to be able to do everything. dispute.

2. Precautions during the operation

1. Be sure to look at the monitor during bronchoscopic surgery. Especially for bleeding people, at least half a minute should be seen, focusing on observing the patient's heart rate, blood pressure, and oxygen saturation, and grasping the patient's condition in real time. Prevent danger.

Tu ECG monitor

2. If the patient does not cough suddenly, it is very quiet, which is a signs of danger. Therefore, communicate with patients in time during the operation. When patients have more severe anxiety and fear, they should suspend their trimmed mirrors if necessary.

3. oxygen saturation

Patient's pulse oxygen saturation decreased significantly during the operation (that is, the absolute value of SPO2 decreased> 4%, or SPO2 <90%) and lasted more than 1min, it should actively increase the concentration of oxygen inhalation, and stop the bronchoscopic operation if necessary to reduce hypoxic -related related to low oxygen -related related Damage occurred.

In addition, at the operation, he should pay attention to observing vascular malformations and other conditions, and beware of hemoptysis. Keep communication with patients during surgery. If hemoptysis occurs, deal with it in time. During surgery, patients with multiple drug resistance and tuberculosis should wear medical protective masks when surgery.

Due to space limitations, the small world is introduced here today. The video takes you at a time to master the precautions of pelvic mirror surgery. In the video, Mr. Sun Danxiong also explained in conjunction with relevant guidelines and literature. Scan the two -dimensional code below to know the small classroom ~

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